When Should We Be Concerned? Recognising Suicide Risk in Adolescents

Talking about suicide in relation to adolescents can be difficult. For parents, teachers, and other adults who care for young people, noticing that something has changed can bring fear, uncertainty, and even the concern of “overreacting.”

Yet paying attention to signs of psychological distress can be an important part of suicide prevention.

Suicide risk does not always present itself in an obvious way, and there is no single characteristic that can determine whether an adolescent is at risk. Instead, it is important to consider changes in behaviour, mood, and the way a young person talks about themselves, their future, and their life.

What signs may raise concern?

Some signs may indicate significant psychological distress, particularly when they represent a clear change from the adolescent’s usual behaviour or occur together with other concerning factors.

• Expressions of hopelessness or worthlessness: feeling like a burden, believing that things will never improve, or expressing that there is no future.
• Talking about death or suicide: this may happen directly or indirectly, through statements such as “I don’t want to be here anymore,” “Everyone would be better off without me,” or “I can’t do this anymore.”
• Social withdrawal: suddenly distancing themselves from friends, family, or activities that were previously meaningful to them.
• Significant mood changes: persistent sadness, irritability, anger, agitation, or unusually intense emotional fluctuations.
• Changes in everyday functioning: noticeable changes in sleep, appetite, school performance, personal care, or daily routines.
• Risk-taking or impulsive behaviour: a sudden increase in dangerous or reckless behaviours can be another element worth exploring.
• Self-harm: episodes of self-harm should always be taken seriously, even when the adolescent says that they do not want to die.
• Unusual goodbyes or giving away possessions: saying goodbye in an unusual way or giving away objects that have significant personal meaning can sometimes be concerning.

It is important to remember that none of these signs, on their own, means that an adolescent is suicidal. At the same time, significant or sudden changes should not simply be dismissed, particularly when several signs appear together.

Why sudden changes deserve attention

One of the most important things to consider is how an adolescent’s current behaviour differs from their usual way of functioning.

A teenager who normally enjoys spending time with friends but suddenly becomes isolated; a student whose academic performance changes dramatically; or a young person who begins expressing intense hopelessness may all be showing signs that something needs further attention.

The goal is not to interpret every behavioural change as a crisis. Adolescence naturally involves emotional and behavioural fluctuations. The important question is whether the change is significant, persistent, unusual for that individual, or accompanied by other signs of distress.

Self-harm and suicide risk are not the same thing

Self-harm and suicidal behaviour are not synonymous.

A person may self-harm without intending to die. For some adolescents, self-harm can be a way of coping with overwhelming emotions, regulating intense psychological distress, or communicating feelings that are difficult to express in words.

However, this does not mean that self-harm should be considered less serious. When self-harm occurs, it is important to understand the circumstances in which it happens and to assess whether suicidal thoughts or intentions are also present.

Professional guidelines recommend an individualised psychosocial assessment following episodes of self-harm rather than relying solely on risk scales or numerical classifications.

Does asking about suicide put the idea in someone’s head?

No. Asking an adolescent whether they have thought about suicide does not cause suicidal thoughts.

In fact, asking directly and calmly can give a young person permission to talk about thoughts they may have been afraid or ashamed to share.

A question could be as simple as:

“I’ve noticed that you’ve been having a really difficult time lately. Sometimes when people feel this overwhelmed, they may start thinking about not wanting to be alive anymore. Have you ever felt that way?”

You do not need to find the perfect words. What matters most is creating an atmosphere in which the adolescent feels safe enough to answer honestly.

What should you do if an adolescent says they are having suicidal thoughts?

The first step is to take what they are saying seriously.

This does not necessarily mean that the adolescent will act on their thoughts. It does mean that they are experiencing a level of distress that deserves attention and appropriate support.

You can:

• remain calm and non-judgemental;
• listen rather than immediately trying to solve the problem;
• ask what they have been experiencing and how long they have felt this way;
• ask directly whether they have thought about hurting themselves or dying;
• avoid promising to keep suicidal thoughts a secret;
• involve a trusted adult and, when appropriate, a mental health professional;
• reduce access to potentially dangerous means whenever possible;
• avoid leaving the person alone when there is an immediate safety concern.

When there is an immediate risk, the priority is not to understand every aspect of the situation. The priority is to keep the young person safe and obtain appropriate emergency support.

When is immediate help needed?

Urgent intervention is particularly important when an adolescent:

• states that they want to die or hurt themselves and describes a concrete intention to act;
• has recently engaged in suicidal behaviour or a serious episode of self-harm;
• appears to be in immediate danger;
• cannot commit to staying safe;
• is experiencing severe psychological or behavioural disturbance associated with an immediate risk of harm.

In Italy, if there is an immediate emergency, call 112, the European emergency number, or 118 for medical emergency services, depending on the circumstances and local service organisation.

The role of adults: being attentive without becoming controlling

When an adolescent is struggling, parents may understandably become hypervigilant. Checking their phone constantly, repeatedly asking whether they are okay, or trying to obtain reassurance can feel like ways of keeping them safe.

Safety, however, is not created through monitoring alone.

Building a relationship in which an adolescent can say “I’m not okay” without immediately fearing punishment, judgement, or an overwhelming reaction is an important part of prevention.

This means creating opportunities for conversations before a crisis occurs: talking about emotions, failure, loneliness, relationships, academic pressure, identity, and worries about the future.

Suicide prevention is not a checklist

It is important to avoid the idea that there is a checklist capable of determining exactly who is or is not at risk.

Suicide risk is complex and can change over time. A meaningful assessment considers an individual’s personal history, current psychological distress, previous experiences, family and social context, available support, and factors that may increase or reduce risk.

For this reason, seeking professional help does not mean that a parent has failed. It means recognising that some forms of psychological distress require specialised support.

Asking for help is already part of prevention

Recognising a warning sign does not mean diagnosing an adolescent. It means stopping, paying attention, and asking: “How is this young person really doing?”

An adolescent who expresses hopelessness does not necessarily need to be interrogated. They need to be heard, taken seriously, and, when appropriate, supported in accessing professional help.

Suicide prevention can begin with seemingly simple actions: asking the right question, listening without judgement, staying present, and recognising when a situation requires more support than we can provide on our own.

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